COVID-19: consider cytokine storm syndromes and immunosuppression

COVID-19: consider cytokine storm syndromes and immunosuppression

March 28, 2020 | Puja Mehta, Daniel F McAuley, Michael Brown, Emilie Sanchez, Rachel S Tattersall, *Jessica J Manson, on behalf of the HLH Across Specialty Collaboration, UK
Since January 2020, Elsevier has established a COVID-19 resource center on Elsevier Connect, providing free information in English and Mandarin about the novel coronavirus. The company has granted permission to make all COVID-19-related research available in PubMed Central and other public repositories, allowing unrestricted reuse and analysis with proper attribution. The article highlights the urgent need for effective treatments for COVID-19, noting that a subgroup of patients with severe cases may experience a cytokine storm syndrome. It recommends identifying and treating hyperinflammation using existing, approved therapies to reduce mortality. The management of COVID-19 is currently supportive, with respiratory failure being the leading cause of death. Secondary hemophagocytic lymphohistiocytosis (sHLH) is an under-recognized, hyperinflammatory syndrome associated with high mortality. The article suggests using the HScore to screen for sHLH and recommends therapeutic options such as steroids, intravenous immunoglobulin, selective cytokine blockade, and JAK inhibition. The correspondence section discusses the clinical features and management of COVID-19, emphasizing the importance of screening for hyperinflammation and the potential benefits of immunosuppression. It also addresses the WHO's declaration of COVID-19 as a pandemic and the practical implications of this terminology.Since January 2020, Elsevier has established a COVID-19 resource center on Elsevier Connect, providing free information in English and Mandarin about the novel coronavirus. The company has granted permission to make all COVID-19-related research available in PubMed Central and other public repositories, allowing unrestricted reuse and analysis with proper attribution. The article highlights the urgent need for effective treatments for COVID-19, noting that a subgroup of patients with severe cases may experience a cytokine storm syndrome. It recommends identifying and treating hyperinflammation using existing, approved therapies to reduce mortality. The management of COVID-19 is currently supportive, with respiratory failure being the leading cause of death. Secondary hemophagocytic lymphohistiocytosis (sHLH) is an under-recognized, hyperinflammatory syndrome associated with high mortality. The article suggests using the HScore to screen for sHLH and recommends therapeutic options such as steroids, intravenous immunoglobulin, selective cytokine blockade, and JAK inhibition. The correspondence section discusses the clinical features and management of COVID-19, emphasizing the importance of screening for hyperinflammation and the potential benefits of immunosuppression. It also addresses the WHO's declaration of COVID-19 as a pandemic and the practical implications of this terminology.
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